Vaccine for all adults who have not received a booster for ten years, and for all health professionals … The strategy is being strengthened to protect infants against whooping cough.
In the midst of “European vaccination week”, the High Council for Public Health draws attention to the flaws in vaccination coverage against “bordetellas pertussis”. “While the primary pertussis vaccination is well performed, the booster shots are not the same: only a little over 50% of adolescents have received five doses of vaccines at 11-13 years old, and 40% of they received the last booster dose at an inappropriate age, around 5-6 years old, recalls Professor Daniel Floret, president of the Technical Committee for Vaccination (CTV). At 18, only 34% of adolescents are protected ”. These practices do not comply with the recommendations of the vaccination schedule: first vaccinations at the age of 2, 3 and 4 months, a booster at the age of 16-18 months, as well as a booster between 11-13 years . But it is young adults who worry the CTV even more. Professor Floret recalls that in 2004, the “cocooning” strategy was introduced. It makes it possible to protect infants too young to be vaccinated (less than three months), by immunizing their parents and those close to them, who are “mainly involved in the contamination”. “We must not forget that whooping cough is not a pediatric disease,” emphasizes Nicole Guiso, head of the pertussis reference center at the Institut Pasteur. It can affect a man at any age in his life, and on several occasions. “” Only 32% of adult pertussis are diagnosed, says Dr Serge Gilberg, from the Necker Hospital – Sick Children (AP-HP, Paris).
Thus, the High Council of Public Health recommended during pregnancy to vaccinate the father, the siblings, and if necessary the adult in charge of the care of the infant during the first 6 months of his life, with the quadrivalent vaccine dTcaPolio. The same goes for the mother, as soon as possible after childbirth. “However, various studies show that this targeted vaccination strategy is little applied,” explains Professor Floret. According to a survey, following the detection of several cases in a maternity hospital in July 2006, only 11% of the 65 mothers questioned replied that they had previously received a vaccination proposal. Another study conducted among physicians belonging to the Sentinels network indicates that while 80% of the practitioners questioned declared having been aware of the new recommendations concerning whooping cough vaccination for adults, vaccination was only given in 35% of cases to patients likely to become parents, 30% at the start of a pregnancy and 25% during the first postpartum consultation. “We noted that nothing had been done to promote the strategy of cocooning”, regrets Professor Floret. Faced with this insufficient vaccination coverage, the Technical Vaccination Committee decided to implement a complementary strategy in its latest recommendations. It recommends the administration of a tetravalent TcaPolio vaccine for adults who have not received a pertussis vaccine for more than ten years.
In addition, to compensate for the change in staff assignment and the frequent call for temporary workers, the recommendation is extended to all health professionals, including in establishments for the elderly (EHPAD). The measure also applies to medical or paramedical students, as well as to early childhood personnel. The Institute for Public Health Surveillance recalls that between 2000 and 2005, among the 35 nosocomial pertussis outbreaks reported, 27 concerned staff. And in three quarters of the cases the contamination occurred from caregiver to caregiver.
Questions to Nicole Guiso, rHead of the Pertussis Reference Center at the Institut Pasteur
“Think about the vaccine for young adults”
Why step up vaccination for adults? Nicole guiso. It should be remembered that whooping cough is not a pediatric disease. It can affect a man at any age in his life. And we can have it several times during its existence. Our children are well vaccinated, and since 1998 our adolescents have been well vaccinated, thanks to the arrival of the acellular vaccine. Since 2004, we have recommended that young adults get vaccinated, especially those of childbearing age, as well as caregivers. But we found that the recommendations are not being followed enough, and the coverage is still too low. We have identified nosocomial infections in several hospitals, or in institutions for the elderly. And in the majority of cases, the disease is brought on by young adults. This is why the Technical Committee has put in place new recommendations.
What about the vaccination of adolescents? N. G. The reminders were only possible in 1998 because before we did not have vaccines to make these reminders. We had vaccines for very young infants, but it had side effects. It was the arrival of the acellular vaccine that made it possible to set up the booster at 11-13 years old. Our adolescents have been vaccinated for ten years. Coverage reaches around 50, 60% of adolescents, but it is not enough. For adolescents who have not had a booster at 11-13 years, we recommend a catch-up at 15-16 years.
What should we take away from this new recommendation? NG. What is important to convey to general practitioners is to really think about pertussis vaccination for young adults. We know that young adults rarely go to their doctor, so practitioners have little opportunity to get the message across. They must not be missed. And more generally, we must remind the population, and health professionals, that to protect infants under three months, in whom the disease can be really dangerous, it is important to be vaccinated. Interview with MG
